title: Acute cholinergic syndrome following ingestion of contaminated herbal extract.
abstract: Herbal preparations are becoming more and more popular and increasingly used in the USA. Herbs are from natural plants and therefore often considered to be harmless compared with western medicines. Nevertheless, as the use of herbal remedies has risen, so has the incidence of acute and chronic herbal intoxication. The case history is presented of a 68-year-old man who presented with an acute cholinergic syndrome soon after ingesting a herbal preparation containing Flemingia macrophylla and ginseng. His red blood cell acetylcholinesterase activity dropped to 50% of the normal reference range. He was treated successfully with atropine and supportive care. It was thought that contamination with pesticides, such as organophosphate residue, was the probable cause. This case highlights the need to be more aware of the possibility of acute pesticide intoxication in herbal users, even when only small amounts are consumed.
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan.
authors.forename: M-J
authors.initials: MJ
authors.lastname: Hsieh
authors.forename: Z-S
authors.initials: ZS
authors.lastname: Yen
authors.forename: S-C
authors.initials: SC
authors.lastname: Chen
authors.forename: C-C
authors.initials: CC
authors.lastname: Fang
mesh_terms: D000110:Acetylcholinesterase / Q000172:deficiency*; D000368:Aged; D004340:Drug Contamination; D004365:Drugs, Chinese Herbal / Q000009:adverse effects*; D004912:Erythrocytes / Q000201:enzymology; D006801:Humans; D008297:Male; D010575:Pesticides / Q000633:toxicity*; D008517:Phytotherapy / Q000009:adverse effects; D013577:Syndrome
chemical_list: D004365:Drugs, Chinese Herbal; D010575:Pesticides; D000110:Acetylcholinesterase